Vomiting for Months

I would really like some help. My husband has been vomiting every day / every other day (usually once or twice per day) since February of 2010. It's now almost February of 2011. In 2011 he will turn 25. He doesn't have any other symptoms. Occasionally he gets nauseous before vomiting, but usually he does not. I can't even tell you how much weight he's lost. He's been to two different gastro doctors and gone through numerous tests (Head MRI, Hida Scan, Billiary Scan, Colonoscopy, Endoscope, and a Gastric Emptying Scan). None of the scans resulted in anything that would cause this much vomiting. The Endoscope showed a medium hiatal hernia and higher than normal levels of stomach acid. They initially thought it was acid reflux and tried a stirct diet along with a few different medicines - Nexium, 2 OTC Prilosecs, Omeprazole, and Dexilant. None of the medicines interrupted his usual pattern of vomiting and it doesn't seem to matter what he eats. Our current gastro has admitted that he can not come up with a diagnosis or an idea for another scan to try. He plans to have my husband try a variety of medicine over the next few months, see if anything helps, and use that information to proceed. Now he is on Dicyclomine and Promethazine. They seem to be helping. The vomiting has slowed to one day every two weeks or so. However, when he does vomit now, it's 8 times per day every two weeks. He gets dehydrated and is very weak on those days to the point where it interferes with his ability to go to work or do much of anything other than have fluids administered at the ER. On those days he gets nauseous all day before vomiting, with very foul burps, even when he's eaten something tame like cereal (the Promethazine is not effective on those days). Is there anyone that has any idea what this could be? I'll take advice too. At this point, we're desperate. Is there another type of specialist he should be seeing?

His next gastro appointment isn't until the end of February, and I can't take much more of this. The pattern has been to wait a month to get into the gastro office, wait a month to get a scan, wait a month to get another gastro appointment to get the results, wait a month to get another scan, and so on. It seems there is no urgency to his care (probably because of his age). I am a patient person and I've trusted our doctors to do the best they can, but there's only so much anyone can take. I have to be very level-headed and calm in front of him because I don't want him to worry about me. I am 23 weeks pregnant. He didn't want us to put our futures on hold because of this and we were sure it would be fixed before we conceived (our current gastro has great reviews from other patients). Essentially, I'm watching my husband deteriorate in front of me and we're only 24. The worry is taking a toll on my life now as well. My performance at work isn't the same. It's difficult to enjoy almost anything. I'm no longer excited about pregnancy. I just pray that someone out there reads this and gives us some piece of information that can point us to a diagnosis. We really need help.

Hi
Welcome to the MedHelp forum!
Since all possible causes of vomiting have been ruled out, there is a possibility that this is cyclical vomiting syndrome. This is characterized by bouts of unexplained vomiting that stop as they came with a symptom free period and start again. There is no test to diagnose it yet. Diagnosis is made by a careful history which shows that each vomiting episode was similar to the previous one in terms of pattern, duration and symptoms.
While this may not have triggers but often triggers are found like emotional stress, inability to adjust to one’s environment, and maybe the pregnancy in your case etc.
Treatment is supportive with medications to stop vomiting, IV fluids, a calm peaceful environment, counseling of the whole family etc.
Also if nothing is found then food challenge test to detect food intolerance should be done. Keep a food diary and see if there is a co-relation between what your husband eats and symptoms that appear. Chronic constipation, sedentary life style building up gas in the gut, inflammatory bowel disease, food rich in sulfites (molasses, dry powder, pickles, tinned shrimp, cookies, crackers, and readymade pie dough), cabbage, raddish etc also cause bloating and nausea & vomiting. Liver and kidney dysfunction is another cause. Hence kidney and liver function tests should be done. Other causes are diabetes and hypothyroidism. Discuss these possibilities with your treating doctor. Take care!

He had an ultrasound done on his first ER visit. It showed nothing. His labs are all normal and I think that is what the doctor is using to rule out liver and pancreas problems. Do you think there are other tests we should be asking about? He has not had an ERCP (at least not in the definition available on Wikipedia that combines the dye and scope). Will that tell the doctor anything a biliary scan won't?

His symptoms do sound very similar to the symptoms listed for CVS. I had never heard of it until now. Maybe the doctor hasn't heard of it either. Or he could be trying to put off a clinical diagnosis until he tries a few more medicines and tests. It seems like a very rare condition. Either way, I will mention it to him. I hope he doesn't think I'm trying to undermine him by going to other resources. That's really not my intention.

I'm not sure, but the symptoms are very similar. One thing I'm not sure about are triggers. Most of the resources mentioned different patients having different triggers to an episode, like anxiety or excitement. I can't think of anything that happens consistently when he has an episode. They also said that there is typically one event that brings the onset of CVS. I don't recall anything happening last February. And he has no family history of CVS or migranes (migraines). However, what makes me lean towards CVS are the descriptions of other patients episodes. The vomiting is very violent, not projectile, but it can occur hours after he eats and it doesn't stop until his stomach is completely empty so it's very painful and sometimes results in an ER visit. Sometimes he gets nauseous, other times he doesn't. When he does have an episode, it's almost like a spasm. And I can classify his experience in episodes with periods of feeling completely healthy inbetween. It looks like many with CVS get relief during an episode with a hot shower. I will have him try this next time. It can't hurt to try it.

Here's some other information. Maybe it's related and maybe it's not. He has had a very stressful life these past 6 years or so. He was an infantryman in the Marine Corps for 4 years. He did two tours in Iraq. Both times he lost his best friends. During the first deployment he was a PFC and was point leader for his fire team (the guy that's the first to go in the building). His convoy was attacked and the vehicle he was in capsized in a river. He drowned and was lucky enough to have a brave friend that somehow managed to find him and pull him out of the water. The coreman estimated he'd been gone for at least a few minutes (but I would think in a situation like that, 10 seconds alone would seem like an eternity). On his second deployment, he was a Cpl and squad leader. His vehicle ran over an IED and he was thrown from the vehicle. He and a few others survived, but he suffered back injury. He continued the deployment once he could walk comfortably again (despite my begging him to come home because they gave him the option). When he returned to the US he had to have surgery to remove a few blood clots that developed because of the impact. His active duty ended in April of 2009. After that we got married and tried for our first baby. Unfortunately, it was a miscarriage. That was in August of 2009. Vomiting started in February of 2010. I wonder if a stressful series of events could trigger CVS? Or is it odd to try to list these things as triggers when they happened about 9 months before he started vomiting? His feelings about these events don't go bottled up. I encourage him to talk to me about them and we do, probably more frequently than other marines anyway. But these are things I know he didn't mention to the gastro doctor. He won't talk about it unless he's asked. Even then he gives short answers unless it's me or his family he's talking to. I'm not sure anymore. Maybe gastro isn't the specialist we need to be seeing.

You said this has been going on for a long time but can you remember if you started cooking with something different as in food or ingredient or even a new pot or pan. I know this sounds silly but you need to keep an open mind because he may be alergic (allergic) to something your not aware of. maybe you changed dish liquids. I'm just trying to help narrow things down.

I'm sorry, I read the hole thing this time and i hear alot of things that could be triggers like losing his buddies and then you having the micarrage. he maybe stressing over the baby because he feels like he's lost so many people he loves and he don't won't to lose another. As a man, i can say we have trouble talking about how we feel and sometimes that can cause more problems,especially if he has been in the war. A therapist might help also.

Hi
Welcome to the MedHelp forum!
Since all possible causes of vomiting have been ruled out, there is a possibility that this is cyclical vomiting syndrome. This is characterized by bouts of unexplained vomiting that stop as they came with a symptom free period and start again. There is no test to diagnose it yet. Diagnosis is made by a careful history which shows that each vomiting episode was similar to the previous one in terms of pattern, duration and symptoms.
While this may not have triggers but often triggers are found like emotional stress, inability to adjust to one’s environment, and maybe the pregnancy in your case etc.
Treatment is supportive with medications to stop vomiting, IV fluids, a calm peaceful environment, counseling of the whole family etc.
Also if nothing is found then food challenge test to detect food intolerance should be done. Keep a food diary and see if there is a co-relation between what your husband eats and symptoms that appear. Chronic constipation, sedentary life style building up gas in the gut, inflammatory bowel disease, food rich in sulfites (molasses, dry powder, pickles, tinned shrimp, cookies, crackers, and readymade pie dough), cabbage, raddish etc also cause bloating and nausea & vomiting. Liver and kidney dysfunction is another cause. Hence kidney and liver function tests should be done. Other causes are diabetes and hypothyroidism. Discuss these possibilities with your treating doctor. Take care!

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